Incidence, Risk Factors and Outcome of Neonatal Acute Kidney Injury: A Prospective Observational Study

Abstract

Introduction
Acute kidney injury (AKI) is common in neonates admitted in neonatal intensive care unit (NICU) and is associated with high death rates and prolonged hospital stay. We aimed to determine the incidence, risk factors and outcome of neonatal AKI in a single tertiary center in Nepal.

Methods
This is a prospective observational study of all neonates admitted to neonatal ICU of TUTH between January 2019 to December 2019. Those with AKI were further assessed for risk factors for and outcomes of neonatal AKI. Neonates who survived or stayed less than 72 hours, evidence of congenital renal anomalies, or with incomplete data were excluded. Need of peritoneal dialysis, mortality and length of NICU stay were the outcomes studied among neonates with AKI. Logistic regression models were used for adjustment of covariates and risk analysis were expressed in terms of odds ratio with its 95% confidence interval.

Results
The incidence of AKI was 37.5% (42/112 patients). Compared with neonates without AKI, those with AKI had a lower birth weight (2421±960 vs 1741±1142gram, p<0.001) and a lower gestational age (36.1±7.8 vs. 32.4±3.9 weeks, p<0.001). Sepsis (OR, 4.5; 95% CI, 0.7–30) and nephrotoxic drug exposure (OR, 4; 95% CI, 1.4–7) were significantly associated with increased AKI risk. Mortality was 40% (17/42) among neonates with AKI and 3% (2/70) among those without AKI (p<0.001). AKI group had a significantly longer stay (mean difference: 14.2 days; 95%CI, 5.5–23days).

Conclusion
Over one third of neonates in NICU developed AKI. Prematurity, low birth weight, sepsis and nephrotoxic drug exposure were the risk factors for neonatal AKI. Mortality was almost fifty percent in neonatal AKI.